It is estimated that Fetal Alcohol Spectrum Disorders (FASD) is the most common neurodevelopmental disability among children throughout the world. Furthering our understanding of the factors that potentially modify risk for FASD, continue to be critical gaps in research that could drive prevention and intervention strategies throughout the world. A longitudinal cohort sample has been established in Ukraine during the current funding period with detailed documentation of prenatal alcohol exposure, maternal nutritional status, and FASD outcomes. In this same sample a multimicronutrient supplement intervention trial has been implemented. During the renewal period, we propose to examine the persistence of and/or the novel manifestation of beneficial neurobehavioral effects of the prenatal multimicronutrient intervention trial, to examine the role of postnatal child nutrition in FASD, an to explore genetic and epigenetic factors as biomarkers of maternal exposure and risk modification among alcohol consuming pregnant women. PUBLIC HEALTH RELEVANCE: Fetal Alcohol Spectrum Disorders (FASDs) are among the most common developmental disabilities throughout the world. Identification of effective methods for prevention and early intervention for FASD is critical. In a longitudinal study in Ukraine, earlier identification and prevention of FASD is being evaluated in four areas: a) the contribution of pre and postnatal nutritional factors to risk for FASD, b) development of a preschool neurobehavioral testing battery appropriate for early identification of affected children c) the utility of a novel and objective biomarker of exposure to alcohol, and d) exploration of genetic and epigenetic factors that may modify risk for FASD in mother/child pairs.